Comparison of real-world outcomes in patients with nonvalvular atrial fibrillation treated with direct oral anticoagulant agents or warfarin

Datar, Manasi; Crivera, Concetta; Rozjabek, Heather; Abbass, Ibrahim M.; Xu, Yihua; Pasquale, Margaret K.; Schein, Jeff; Andrews, Gordon

doi:10.1093/ajhp/zxy032

Cited by 18 publications

(12 citation statements)

References 31 publications

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“…However, with the advent of direct acting oral anticoagulants (DOACs), there has been a shift in practice toward these newer agents, but there are scant data to aid in anticoagulation decision making as solid organ transplant recipients are poorly represented in the literature 1‐3 . DOACs have clear advantages over warfarin with more predictable kinetics, fewer drug‐drug and drug‐food interactions, and do not require therapeutic drug monitoring 4,5 . Furthermore, DOACs do not require peri‐procedural bridging which may improve patient safety and reduce length of stay 6 …”

Section: Introductionmentioning

confidence: 99%

A retrospective analysis of the safety and efficacy of apixaban use after lung transplant

Reininger

Sam

Patel

et al. 2021

Clinical Transplantation

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When anticoagulation is indicated following lung transplantation, warfarin has long been the enteral anticoagulant of choice. However, with the advent of direct acting oral anticoagulants (DOACs), there has been a shift in practice toward these newer agents, but there are scant data to aid in anticoagulation decision making as solid organ transplant recipients are poorly represented in the literature. [1][2][3] DOACs have clear advantages over warfarin with more predictable kinetics, fewer drug-drug and drug-food interactions, and do not require therapeutic drug monitoring. 4,5 Furthermore, DOACs do not require peri-procedural bridging which may improve patient safety and reduce length of stay. 6 The lung transplant population has unique characteristics that necessitate caution with integration of DOACs into practice. Drug interactions are common as lung transplant patients are likely to receive concomitant CYP3A4 and P-glycoprotein (P-gp) inhibiting medications. Inhibition of CYP3A4 metabolic activity may decrease metabolism of substrates, such as apixaban, and hence increase serum concentrations. Inhibition of P-gp may increase intestinal absorption as well as systemic distribution of P-gp substrates, including apixaban. In lung transplant, common CYP3A4 inhibitors include azole antifungals and diltiazem. Medications such as cyclosporine, amiodarone, and itraconazole inhibit both CYP3A4 and P-gp. Management of these interactions is complicated by different degrees of CYP3A4 inhibition (eg, voriconazole is a more potent

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Section: Introductionmentioning

confidence: 99%

A retrospective analysis of the safety and efficacy of apixaban use after lung transplant

Reininger

Sam

Patel

et al. 2021

Clinical Transplantation

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“…An additional advantage of NOACs over warfarin based on comprehensive comparisons of real-world outcomes in patients with AF was the substantial reduction in healthcare costs. 45 Moreover, expenditure for all-cause hospitalization and outpatient medical care were lower for NOACs compared with warfarin. 46 In terms of practicality and patient satisfaction, a further advantage of NOACs was related to better patients adherence due to ease of use with no need for frequent laboratory monitoring or dose adjustments.…”

Section: Non-vitamin K Antagonist Oral Anticoagulants As a Groupmentioning

confidence: 99%

Practice-derived data on non-vitamin K antagonist oral anticoagulant therapy to complement observations from randomized trials

Domek

Gumprecht

Ding

et al. 2020

European Heart Journal Supplements

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Anticoagulation is fundamental in the management of patients with atrial fibrillation (AF). The study aims to provide a comparative review of the major phase III randomized clinical trials (RCTs) and real-world data (RWD) from reliable, high-grade Phase IV studies that assess the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) vs. vitamin K antagonists (VKAs). Observational studies based on nationwide or health insurance database records on the use of NOACs vs. VKAs in patients with AF were included. We performed a comparison of the efficacy and safety characteristics associated with NOACs vs. VKAs in RCTs and RWD. Although RCTs provide strong support for evidence-based practice, RWD may be used to reflect the broader picture of various clinical settings, provide supplementary insight and fulfil knowledge gaps. Both study types confirmed the safety and efficacy of NOACs in preventing stroke and thromboembolism in patients with AF. In comparison to VKAs, NOACs were associated with reduced risk of ischaemic events and lower rates of adverse events such as major bleeding or intracranial haemorrhage. Administration of NOACs might be associated with increased risk of dose-related gastrointestinal bleeding and myocardial ischaemic events, especially in the early treatment period after switching from VKAs. Special care should be taken in challenging clinical situations like severe renal or hepatic impairment when the treatment regimen needs to be considered individually. Randomized clinical trial and RWD studies are complementary and present comparable findings, affirming that NOACs are safe and effective for anticoagulation of patients with AF in daily clinical practice.

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“…The advent of NOACs has improved the management of patients with NVAF by overcoming the limitations associated with traditional OAC drugs. Safety, efficacy, and effectiveness of NOACs have been confirmed by meta-analyses of randomized trials [16,[25][26][27][28][29] and realworld studies [30][31][32][33]. In addition to the effects on clinical outcomes (decreased risk of stroke, bleedings, and death compared to warfarin), NOACs are associated with rapid onset of action, fixed dosing, no need for INR monitoring, and fewer food and drug interactions.…”

Section: Discussionmentioning

confidence: 88%

An Integrated Management Model of Patients With Atrial Fibrillation: The Experience of the Local Health Unit Tuscany North-West

Casolo

Cavirani²,

Carlo³

et al. 2019

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Atrial fibrillation (AF) is the most prevalent form of alteration in cardiac rhythm and is associated with a high economic burden resulting from both clinical consequences and impact on patients’ quality of life. Goals of treatment include symptom control and, in the high-risk patients, the prevention of thromboembolic complications. The advent of novel oral anticoagulant agents (NOACs) has improved the management of patients with non-valvular AF (NVAF) by overcoming limitations associated with traditional oral anticoagulation drugs. NOACs are associated with a lower risk of stroke, systemic embolism, and mortality compared to vitamin K antagonists (VKAs) and with a lower risk of fatal, major, and intracranial bleeding. This supplement aims at sharing the virtuous management model of AF patients in the Local Health Unit Tuscany North-West and promoting the importance of a multidisciplinary management, which involves cardiologists and general practitioners (GPs), not only in terms of clinical outcomes, but also of therapeutic appropriateness and economic sustainability.

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Comparison of real-world outcomes in patients with nonvalvular atrial fibrillation treated with direct oral anticoagulant agents or warfarin

Cited by 18 publications

References 31 publications

A retrospective analysis of the safety and efficacy of apixaban use after lung transplant

A retrospective analysis of the safety and efficacy of apixaban use after lung transplant

Practice-derived data on non-vitamin K antagonist oral anticoagulant therapy to complement observations from randomized trials

An Integrated Management Model of Patients With Atrial Fibrillation: The Experience of the Local Health Unit Tuscany North-West

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